title: The impact of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers in patients with Clostridium difficile infection.
abstract: There is increasing frequency and severity of disease due to Clostridium difficile infection (CDI). In addition, failure of initial antibiotic therapy is increasing. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARBs) may have local and systemic anti-inflammatory properties to reduce severity of disease in CDI. We performed a retrospective study of 306 patients with CDI over 23 months at a single center in Detroit, Michigan. Patient outcomes (death, death due to CDAD and relapse rates) were compared based on the use of ACEI or ARB during an episode of CDI. A total of 116 (37.9%) patients received an ACEI/ARB and 190 (62.1%) did not. The groups were similar except ACEI/ARB patients were older (71.9 vs. 64.3, P<0.0005) and had a higher frequency of congestive heart failure (50.9% vs. 30.2%, P<0.0005) and chronic obstructive pulmonary diseases (44.8% vs. 30.2%, P<0.010). ACEI/ARB patients had lower overall mortality rates (9.5% vs. 23.3%, P<0.002) as well as mortality due to CDI (2.6% vs. 8.6%, P<0.036). The rate of CDI relapse was not significantly different between the groups (5.2% in ACEI/ARB vs. 10.0%, P=0.135). Logistic regression analysis demonstrated that ACEI/ARB use was associated with lower overall mortality rate (OR 0.26; 95% CI, 0.12-0.55) and mortality due to CDI (OR 0.29; 95% CI, 0.08-1.02). Our findings suggest that ACEI/ARBs may have a role as an adjuvant therapy to antibiotics in patients with CDI. Prospective studies are needed to confirm these results.
authors.affiliation: Department of Internal Medicine, 1 Oak Forest Hospital of Cook County, Chicago, IL, USA.
authors.forename: Shilpa M
authors.initials: SM
authors.lastname: Patel
authors.forename: Evan
authors.initials: E
authors.lastname: Stashefsky
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Maroun
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Johnson
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors